Probate: other; designation of a patient surrogate for health care decisions; allow. Amends 1998 PA 386 (MCL 700.1101 - 700.8206) by adding pt. 6 to art. V & repeals sec. 66h of 1939 PA 280 (MCL 400.66h). TIE BAR WITH: HB 4419'25
HB 4418 would add a new Part 6 to Michigan’s Estates and Protected Individuals Code to create a statutory framework for “surrogate” decision makers for health care. The bill allows an adult or emancipated minor who is not incapacitated and is admitted to a health care facility to designate a surrogate in writing, or by other communication methods with witness requirements if writing is not possible. If no patient-designated surrogate, patient advocate, or guardian is available, the bill establishes a priority list of potential surrogates, beginning with a guardian or attorney-in-fact and then moving through spouse, adult child, domestic partner, parent, adult sibling, co-resident, and finally another adult with special care and concern for the patient.
The surrogate may make health care decisions for a patient who lacks decision-making capacity, but only under specified conditions and subject to limits. The bill requires the surrogate to act in the patient’s best interests and under fiduciary standards, prohibits compensation beyond reimbursement of necessary expenses, and bars the surrogate from making certain decisions such as binding the patient to arbitration without authorization or moving the patient out of state without a court order. It also requires documentation in the medical record, notice to family members in some circumstances, and procedures for resolving disputes over who should serve as surrogate.
The bill’s impact on state law is to formalize and expand the authority of non-guardian, non-patient-advocate individuals to make health care decisions when a patient is unable to do so, while preserving existing patient advocate and guardian provisions. It amends the Estates and Protected Individuals Code and interacts with the Public Health Code by cross-referencing standards for capacity, patient rights, and health care recordkeeping. It also gives surrogates and authorized decision makers access to medical information similar to the patient’s rights for disclosure and records.
The general sentiment reflected in the voting history is strongly supportive and noncontroversial. The bill passed the House 98-0 on third reading and was reported out of committee unanimously, indicating broad bipartisan agreement. The available record does not include committee debate, but the unanimous votes suggest the bill was viewed as a practical fix to clarify who may make urgent health care decisions when a patient lacks capacity.
The main points of contention addressed in the bill itself are not partisan disputes but safeguards and eligibility limits. The legislation restricts who may serve as surrogate, excludes people subject to protective orders or certain criminal proceedings, allows patients to disqualify a surrogate, and gives priority to higher-ranking relatives if they become available. It also limits authority over end-of-life treatment, arbitration agreements, and out-of-state relocation, reflecting concern about preventing abuse while still ensuring timely medical decision-making.
HB 4418 would add a new statutory mechanism in Michigan law for appointing and using health care surrogates, creating a detailed hierarchy of who may act when a patient lacks capacity and has no available patient advocate or guardian. It would amend the Estates and Protected Individuals Code and coordinate with the Public Health Code on capacity determinations, patient rights, and medical-record documentation. The bill would affect hospitals, physicians, health care facilities, patients, families, guardians, attorneys-in-fact, and patient advocates by clarifying authority, notice requirements, and limits on surrogate decision-making.
The bill appears to have broad, bipartisan support and little visible opposition in the available record. It passed the House 98-0 and was reported from committee unanimously, suggesting lawmakers generally viewed it as a useful and necessary clarification of health care decision-making authority. The lack of recorded dissent or transcript debate points to a consensus-oriented measure.
The bill’s notable tensions center on balancing access to surrogate decision-making with protections against misuse. Potential concerns include who should have priority, how to verify authority, whether a surrogate may override prior patient wishes, and how to prevent conflicts of interest when a surrogate is also connected to the patient’s care setting. The bill addresses these issues by excluding certain individuals, requiring documentation and notice, allowing patient disqualification, and limiting authority over arbitration and relocation. Any disagreement would likely arise around the scope of surrogate power and the safeguards needed to protect vulnerable patients rather than around the concept of surrogacy itself.